* Indicates required information
Date of Incident *
What happened? *
Did you suffer a financial loss? *
Did the scammer ask for payment?
Did you pay the scammer?
Cash payment information
Who did you send your cash payment to?
Where was the cash payment sent?
Shipping method
Wire payment information
Who did you send the wire payment to?
Where did you send the wire to?
Did you provide additional payments?
(Note: Copying and pasting text from external applications may result in an error)
Did you provide personal or sensitive information to the scammer (other than your full name, telephone number, or address)?
Scammer information
Scam Details
(Note: Copying and pasting text from external applications may result in an error)
Your Information
5-digit security PIN *
Please memorize and write down your 5-digit PIN before submiting the form